Demographic Survey
What is your age? __________ What is your gender?
Male Female Trans-Female Trans-Male Other_________
What is your sexual orientation? Heterosexual Gay Lesbian Bisexual Pansexual Asexual Other__________
What is your academic status? Freshman
Sophomore Junior Senior
Graduate Student
How do you identify your race? You can provide a description. Asian or Asian-American__________
Black, African-American__________
Hispanic, Latino, Mexican-American__________ Pacific Islander__________
Native American or American Indian__________ White, European American__________
Multicultural Mixed Race__________ Other, please specify__________
The following questions refer to counseling given by a trained clinician, such as a psychologist, counselor, or social worker. This does NOT include counseling received from a religious figure, family member, or friend.
Are you currently receiving counseling services? This refers to any meeting in a counseling center (or similar setting) whether it be a one-time initial meeting or ongoing services
Yes No
In what type of counseling services are you participating (select all that apply)? Individual Counseling
Group Counseling Other________
How long (in months) have you been in counseling? _________
What is the estimated number of sessions you have attented? _____________
What is the primary reason for seeking counseling services? ________________
Appendix B
SAPS (Short Almost Perfect Scale)
Rice, Richardson, & Tueller, 2014
The following items are designed to measure certain attitudes people have toward themselves, their performance, and toward others. It is important that your answers be true and accurate for you. In the space next to the statement, please enter a number from "1" (strongly disagree) to "7" (strongly agree) to describe your degree of agreement with each item. STRONGLY DISAGREE 1 DISAGREE 2 SLIGHTLY DISAGREE 3 NEUTRAL 4 SLIGHTLY AGREE 5 AGREE 6 STRONGLY AGREE 7
1. I have high expectations for myself. 2. Doing my best never seems to be enough. 3. I set very high standards for myself.
4. I often feel disappointment after completing a task because I know I could have done better.
5. I have a strong need to strive for excellence.
6. My performance rarely measures up to my standards. 7. I expect the best from myself.
8. I am hardly ever satisfied with my performance.
Citation:
Rice, K. G., Richardson, C. M., & Tueller, S. (2014). The Short Form of the Revised Almost Perfect Scale. Journal of Personality Assessment, 96, 368-379.
Appendix C
F-MPS-Brief (Frost Multidimensional Perfectionism Scale – Brief)
Burgess, Frost, & DiBartolo, 2016
Please answer the following questions in relation to how much they apply to you. Do not spend too much time on any one question.
Strongly Disagree 1 Disagree 2 Neutral 3 Agree 4 Strongly Agree 5
_____ 1. If I fail at work/school, I am a failure as a person. _____ 2. I set higher goals for myself than most people.
_____ 3. If someone does a task at work/school better than me, then I feel like I failed at the whole task.
_____ 4. I have extremely high goals.
_____ 5. Other people seem to accept lower standards from themselves than I do.
_____ 6. If I do not do well all the time, people will not respect me. _____ 7. I expect higher performance in my daily tasks than most people.
_____ 8. The fewer mistakes I make, the more people will like me.
Citation:
Burgess, A.M., Frost, R.O., & DiBartolo, P.M. (2016). Development and Validation of the Frost Multidimensional Perfectionism Scale–Brief. Journal of Psychoeducational Assessment 34(7), 620–633. doi:10.1177/0734282916651359
Appendix D
Multidimensional Psychological Flexibility Inventory (MPFI)
Never True Rarely True Occasionally True Often True Very Often True Always True Flexibility Subscales
Acceptance Defusion
In the last two weeks…… In the last two weeks…… I was receptive to observing unpleasant thoughts and feelings without
interfering with them
I was able to let negative feelings come and go without getting caught up in them
I tried to make peace with my negative thoughts and feelings rather than resisting them
When I was upset, I was able to let those negative feelings pass through me without clinging to them
I made room to fully experience negative thoughts and emotions, breathing them in rather than pushing them away
When I was scared or afraid, I was able to gently experience those feelings, allowing them to pass
When I had an upsetting thought or emotion, I tried to give it space rather than ignoring it
I was able to step back and notice negative thoughts and feelings without reacting to them
I opened myself to all of my feelings, the good and the bad In tough situations, I was able to notice my thoughts and feelings without getting overwhelmed by them
Present Moment Awareness Values
In the last two weeks…… In the last two weeks……
I was attentive and aware of my emotions I was very in-touch with what is important to me and my life I was in tune with my thoughts and feelings from moment to moment I stuck to my deeper priorities in life
I paid close attention to what I was thinking and feeling I tried to connect with what is truly important to me on a daily basis I was in touch with the ebb and flow of my thoughts and feelings Even when it meant making tough choices, I still tried to prioritize the
things that were important to me I strived to remain mindful and aware of my own thoughts and
emotions
My deeper values consistently gave direction to my life
Self As Context Committed Action
In the last two weeks…… In the last two weeks……
Even when I felt hurt or upset, I tried to maintain a broader perspective Even when I stumbled in my efforts, I didn't quit working toward what is important
I carried myself through though moments by seeing my life from a larger viewpoint
Even when times got tough, I was still able to take steps toward what I value in life
I tried to keep perspective even when life knocked me down Even when life got stressful and hectic, I still worked toward things that were important to me
When I was scared or afraid, I still tried to see the larger picture I didn't let set-backs slow me down in taking action toward what I really want in life
When something painful happened, I tried to take a balanced view of the situation
I didn't let my own fears and doubts get in the way of taking action toward my goals
Never True Rarely True Occasionally True Often True Very Often True Always True Inflexibility Subscales
Experiential Avoidance Fusion
In the last two weeks…… In the last two weeks……
When I had a bad memory, I tried to distract myself to make it go away Negative thoughts and feelings tended to stick with me for a long time. I tried to distract myself when I felt unpleasant emotions Distressing thoughts tended to spin around in my mind like a broken record. When unpleasant memories came to me, I tried to put them out of my mind It was very easy to get trapped into unwanted thoughts and feelings. When something upsetting came up, I tried very hard to stop thinking about
it
When I had negative thoughts or feelings it was very hard to see past them. If there was something I didn't want to think about, I would try many things
to get it out of my mind
When something bad happened it was hard for me to stop thinking about it. Lack of Contact with the Present Moment Lack of Contact with Values
In the last two weeks…… In the last two weeks……
I did most things on "automatic" with little awareness of what I was doing. My priorities and values often fell by the wayside in my day to day life I did most things mindlessly without paying much attention. When life got hectic, I often lost touch with the things I value
I went through most days on auto-pilot without paying much attention to what I was thinking or feeling
The things that I value the most often fell off my priority list completely I floated through most days without paying much attention. I didn't usually have time to focus on the things that are really important to
me Most of the time I was just going through the motions without paying much attention
When times got tough, it was easy to forget about what I truly value
Self as Content Inaction
In the last two weeks…… In the last two weeks…… I thought some of my emotions were bad or inappropriate and I shouldn't
feel them
Negative feelings often trapped me in inaction I criticized myself for having irrational or inappropriate emotions Negative feelings easily stalled out my plans I believed some of my thoughts are abnormal or bad and I shouldn't think
that way
Getting upset left me stuck and inactive
I told myself that I shouldn't be feeling the way I'm feeling Negative experiences derailed me from what's really important
I told myself I shouldn't be thinking the way I was thinking Unpleasant thoughts and feelings easily overwhelmed my efforts to deepen my life
Citation:
Rolffs, J.L., Rogge, R.D., & Wilson, K.G. (2016). Disentangling components of flexibility via the hexaflex model: Development and validation of the Multidimensional Psychological Flexibility Inventory (MPFI). Assessment, 1-25.